Wednesday, November 18, 2015

Interesting times for the visually impaired - technologically speaking!

These are interesting times for the visual impaired, technologically speaking at least. The number of advances in technologies for the eyes and the eye-brain interface, because a lot of the impairment is in our heads, has really started to amaze me, and they seem to be occurring every day. An idea to write a blog post on this has been brewing for sometime. This post was sparked by a story I read today about a little girl of seven years of age who was blind almost since birth because of a stroke and who was not allowed to carry her white cane (that is a technology too!)  to school. Not such an interesting time for her because it is a health and safety concern?

Also today I read about a bionic lens made by Ocumetrics that will return better than 20/20 vision by 3 times. That is in clinical trials but the promise is an 8 minute out patient "surgery". Just a couple of weeks ago I heard about a technology discovery that could replace our weak eye lenses with an LCD equivalent - liquid crystal sight - like having a smartphone camera lens implanted in our eyeballs and connected through the nervous system to the brain. That would really help, maybe even cure, older folks with presbyopia.

The idea that technology was rapidly moving ahead to aid the visually impaired occurred to me more than several years ago when I was made aware of a research study involving smartphones and the blind. In there was the idea that crowdsourcing could help the blind in a very simple way - especially those times when they were in a bit of a bind. All they have to do is use their smartphone to take a picture of the object of thing they can't identify, for example, a soup can, upload the picture to a crowdsourcing website, and wait for one of the minions who make working there a 24/7 enterprise. After a short wait in the kitchen they get a text to speech email spelling out for them the "tomato soup can" they wanted to open for lunch.

What if they could even eliminate the crowdfunding middle person? Yes, let's impoverish those already impoverished Mechanical Turks working for pennies again!  Why not just upload the image to a search engine that can identify images? It would have to be one customized to return a text to speech SMS. Then again we would have to trust in the artificial intelligence of the image recognition software. There is an ethical dilemma there, because that might not be a can of tomato soup for lunch! Another way to look at that is computer image recognition software that could read braille and translate it into text to speech? Google informs me via Wikipedia that that might be called "optical braille recognition". That idea occurred to me today when I saw a potentially new prothesis that can sense touch.

Of course, one of the great pioneers of all of this, Ray Kurzweil, was inspired to invent in order to help the visually impaired. He developed many text to speech products, like a Reading Machine that advanced Optical Character Recognition, Flatbed Scanners, and Text to Speech. One of his customers was the truly great though blind musician Stevie Wonder who got him into music apparently, and the Kurzweil synthesizers followed.

One of the most breath taking of the smartphone app devices to help the visually impaired is the KNFB reader. This is an app for a smartphone that allows the blind to pick up text off of virtually anything. This youtube video illustrates how it is used very well:

I have a personal interesting in the technology for visual impairments because I have amblyopia, or lazy eye. I have blogged a little about the video game intervention research that is so exciting as a novel and interesting way for kids to potentially fully regain vision in their lazy eye.  The game technology devices are getting more customized (sort of binocular suppression- see Hess, McGill University) as researches learn more about how the brain works. I have been in a clinical trial to see if adults can regain visual ability in the lazy. Not that much success for me but I am still keenly interested in it. I am especially interested given the fact that Transcranial Magnetic Stimulation in a certain area of the brain and at a certain frequency will restore perfect vision in adults with lazy eye, but only for 45 minutes! See, it is really all just in our heads! Eventually the bridge will be made there, I am hoping, without having to shock ourselves under that infinite loop coil of the TMS device more than several times a day.

There are a lot of other technologies for visual aids for professionals. There is an infrared visual smart glasses that let nurses see the veins in the arm better for intravenous needles. Google glass looks promising for some professional healthcare occupations, even in the surgery. Apparently Facebook is also working on ways to help the blind "see images".

Another smartphone development by a group called Peek Vision offers promising low cost diagnostic or comprehensive eye exam software on a smartphone. Needless to say, because it is mobil, remote villages in Kenya and elsewhere can now intercept patients with potentially serious eye or other health conditions:

Thursday, October 22, 2015

myCARE patient portal

New patient portals launched, but lots more needed

Alex LambertSAULT STE. MARIE, Ont. – The Group Health Centre in Sault Ste. Marie, Ont., has joined the ranks of healthcare organizations offering a patient portal with secure access to test results and much more.

The Group Health Centre has launched myCARE, a secure online patient portal that provides patients with the ability to send messages to their healthcare team, request prescription renewals, manage appointments, and review lab test results online.

A survey of the more than 1,500 patients who were involved in the pilot phase reported that:
• 99 percent of patients surveyed would recommend myCARE to a friend or family member
• 97 percent agree that myCARE is user-friendly
• 93 percent agree it was easy to register
• 90 percent agree it’s easy to use

Alex Lambert (pictured), CEO of Group Health Centre, is confident that the launch of myCARE will help improve access to care and advice for patients.

“We believe healthcare is most effective when patients are engaged,” he said. “myCARE offers patients a number of unprecedented options for access, information, and communication. This kind of patient engagement leads to better outcomes for everyone involved.”

Michael Green, president and CEO of Canada Health Infoway, wants to maintain the momentum.

“While Canadians are ready for e-booking and viewing lab results online, only 6 to 10 percent have access now,” added Green. “The potential to enhance Canadians’ patient experience by improving care and reducing the amount of time required to renew prescriptions, book appointments and manage illness has never been greater than it is today.”

That view is echoed by leading Canadian health care organizations who have established Digital Health Week (November 16 – 22, 2015) to recognize how digital health is transforming care and helping to improve delivery of care across the country.
Think digital health isn’t making a difference? Think again. Visit

Thursday, October 8, 2015

CBC - Keeping Canada Alive website design & programming

The navigation web programming & design is excellent for this CBC project.

I looked at the Page Source for the coding trying to see if I could identify how they designed it. I am still not sure. I missed the ajax boat in programming utility and so I am not sure how that programming forms the navigation circle, if at all. Some of the navigation circle might be all done in CSS, maybe what they call "CBCcarousel":
Then I found out that "carousel" is actually a CSS class for design < here >.

It reminded me of an old style of web page design using photoshop image over layers.  The circle mouse over links to entire video documentaries is very useable. CBC may be selling off their buildings and laying off employees but at least they know how to deliver digital information. It could even be flash scripting? I've really not kept up with that either.

I think web design and programming for healthcare sites is part of a study of Health Informatics. We may recall the fiasco of the Obamacare website that had usability and server crashing issues.  For that matter, any electronic medical record system is first and foremost a web design application that must prioritize usability.

Speaking of Usability I have been trying to read through Steve Krug's "Rocket Surgery Made Easy: The Do-It-Yourself Guide to Finding and Fixing Usability Problems." Krug is right - he is not a book writer. Interesting layout for a book though.

The episodes for the CBC series don't appear to have one dedicated to an ehealth contextual scenario. I think that is because ehealth is usually kind of implicated throughout many aspects of healthcare, and not an all star focus?

Anyway, having watched a half dozen or so episodes, I am finding the whole thing quite an awesome educational trip! Here is a short clip intro to the project:

Tuesday, August 11, 2015

Humans TV Series Reviews on IEEG

I noticed two reviews on the Institute for Ethics & Emerging Technology on the new TV Series "Humans".

Spoiler alert in effect, but here is the review by Adrian Cull.
Here is the review by Nicole Sallak Anderson.

I have not seen the TV series but I think the ideas for this kind of science fiction were mined from the film directed by Steven Spielberg in 2001 called  "AI".

As one reviewer for the Humans TV series says, it is good that the public is starting to think about the ethics of this technology.

Sunday, August 9, 2015

Human Error or Garmin Map Error - Again!

GPS accuracy is getting more and more precise apparently. The open street map website has an article about it <here> and so does the US Air Force government site dedicated to GPS <here>. So, I don't really know which satellite to take to task for leading me down to a dead end road after 32 miles of twists and turns and the same number of miles away from my objective! In fact however, the problem could have totally been between my brain and the device - an acronym computer users have often referred to as PEBCAK (Problem Exists Between Chair and Keyboard).

I was in Silicon Valley for a week and again was able to use a Garmin navigation device in my rented car to help me get around. The Garmin proved very useful our first visit to San Francisco, though not entirely without a few hiccups.  Turns out that Garmin is also making a fitness device called the vivoactive which is also GPS equipped, but this article is focusing on cars (and is demonstrably non-ehealth). Extreme Tech has an interesting article on how getting lost these days in a car is a lost art! However, I think getting lost while driving is an art, as long as it is intentional, and you don't need all the tech to do it. I still don't have a smart phone (or roaming charges) for example, to help get me out of lost.

One of the beauties of driving in the San Francisco bay area is going down Highway 1 towards Big Sur. This is a breathtaking trip for landlocked Ontarians like myself and I have done this before on a previous one week stay. I have been down that 17 mile scenic highway that goes through the famous Pebble Beach golf course. I had seen the magnificent vistas of rock, beach, ocean and mountains (and the palaces and homes of the plutocratic rich).

It was towards Big Sur again when I made an unfortunate decision to turn left onto Carmel Valley Road just outside of Monterey, instead of right towards the 17 Mile Road and Highway 1, where all the other cars were lined up to go. The voice of the Garmin GPS was saying turn left onto Carmel Valley Road,(G-16) while my gut instinct was saying that was the wrong way to go.

Now, the Carmel Road name seemed strangely familiar to me. Every time before a road trip I will consult my iPad Google maps the night or morning before and try to memorize routes. It just so happened that we were in a Starbucks that has WiFi just 5 minutes before this turn but I did not spend that much time consulting directions - it was a no brainer just to take Highway 1. Still, this time, I was going to give the Garmin GPS the benefit of the doubt. I have ignored it before while successfully trusting my own sense of direction, but this time it appeared that it might be right, or at least intriguingly possibly, even though all the other cars clearly were not heading in that direction.

About 5 months before our trip I was studying Google maps about this area of California. I was looking in anticipation to our up and coming trip. I was trying to find the location of the Tassajara Zen Centre, that had a remote meditation retreat centre somewhere. I had long been a fan of the well known Tassajara Cookbook.  I found out that it was in such a remote area in the mountains south of Monterey, that the final stages could not even be reached by car. I had read that some people with 4 by 4 or off road vehicles could get close to it though. This was not a trip I imagined my wife would ever be in favour of making. If I had recalled at all, I would have remembered that the Tassajara Zen Centre, was accessed first along the Carmel Valley Road. That is perhaps why the name seemed familiar but it did not come into my consciousness until I noticed the road sign (probably the only one on the G16 route for all it's 30 miles length), that said Tassajara Rd!

The 6 miles or so road to the village of Carmel is just fine and there are many signs of civilization in the form of California haciendas, ranches, camps, and a few horse stables, stores, whatnot. There was even a collection of vintage cars coming at us from an Exhibition near the Carmel village.  Because of the drought this summer, everything is bone dry. All the mountains are brown. When we visited during the winter month of December it rained all the time in San Francisco, the mountains are green and it gets pitch black by 5:00pm. It really looks like dry gultch desert Western country out here now. Just outside the village though, the road immediately is less paved and maintained, and narrower, and then it starts to twist and turn, delivering at the same time a forboding sense of starting a journey into remote uncharted regions of the Garmin map. I have been on twisting and turning roads before but after about 7 miles I pull over to consult the GPS. I am not going to be able to take much more of this, nor could the nerves of my wife.

I zoom out of the small GPS location on the Garmin screen for a bigger picture. It looks like another 30 miles of this kind of road and I am not too sure where it ends. I am hoping a beautiful vista of Big Sur and waves breaking on the coast. Little did I know that my subconscious yearning to explore the terrain near Tassajara was leading me on. After about 10 miles of twists and turns, the painted line in the middle of the road long ago disappearing, absolutely no cars seen in both directions, we do come to a vista, but it is of a remote and vast expanse of browned-out grassy dry mountains fading away off in the distance, with just the hint of the road ahead, turning and twisting. Gut wrenching decision to just continue on, hoping against hope that GPS is not wrong again. It has been wrong before. Never trust that accursed device!

In another frame of mind I would not mind this trip. I would enjoy the blue sky, the barreness, the expanding mountainous views, and the solitude. But I am clutching onto the steering wheel, and going cautiously around blind turns.  The same morning driving in from San Mateo we took the Skyline Boulevard down to La Honda, a pretty drive along the mountain edge looking out over Silicon Valley, with giant cedar trees, no human habitations, and winding roads. Unfortunately it also had hundreds of cyclists hogging the lane, and often a peloton of Porches gunning trough gear changes on the twisting road - some sort of Silicon Vally millionaires Sunday morning fun in our Porches club - and we saw more than several teams of them. I had been in a head on car accident as a kid on the small dirt roads in Northern Ontario, a truck coming over the hill in the centre of the road blind to us oncoming. I know we are nowhere near human habitation now, and we don't have a smartphone. We do have enough gas. My wife, a natural worrier, is not making this stress any easier. Then I saw the road sign indicting Tassajara Rd leading off to the right. It was the first branching road we came across after 15 miles, and I knew that I had unconsciously deceived myself for good. Biggest fool on planet Earth - me - bigger than the mountains on Pluto (way off from the Earth). And about to be greater.

Thankfully there were no cliff edge look overs into sheer drops into bottomless ravines, no nothing quite like that. We seemed to be blazing through a lower elevation in the mountains, that were tending to get higher as we progressed. It wasn't until we heard the Garmin navigator suddenly speak after an hour of radio silence -  "Turn right on Arroyo Seco" - that the mountainous terrain began to soar over our heads - huge great peaks up to over 2000 meters - I was not really sure how high as I was king of afraid to look up and take my eyes off the road. We really felt like we had broken through into a different terrain altogether, but there was no ocean there. I am still trying to locate these mountains on Google Earth but I believe it is in the Santa Lucia range. After 32 miles of twists and turns Arroyo Seco is a freshly paved highway with a painted line down the middle and we heading off to very soon seeing the beautiful mountains and ocean of Big Sur, or so we hope against hope.

We had gone only a few miles down Arroyo Seco (which means dry creek or something), when we came to what appeared to be a dead end. It was not possible! We had arrived at a park gate house. I just googled it now and it is the Arroyo Seco Campground in the Ventana wilderness and the Los Padres National Forest. Four park ranger people appeared to be crammed into the little gate house. I look ahead and see that our freshly paved road does a complete tight circle around the gate house. GPS error again! The impossible is possible. I asked the park rangers if the road continues on to Highway 1. Apparently it used to, up until 1995, but all that is left now is only fit for horses, mules or hikers.  I guess this isn't the way to Big Sur then, and I hear them chuckling inside. "You wouldn't be the first to make a GPS mistake and end up here". Guess not. The problem now, is how to get back? Don't tell me we have to take the same road back!

Yes, in fact, taking the same road back was the best option. It was coming on to 6:00pm. It would soon be getting dark. Our day trip to Big Sur was over. We would never get there that day before almost sunset. The two other options were going back the newly paved road to Greenfield then up Highway 101 to Soledad and eventually San Jose and San Francisco. I didn't think to ask them to actually see a paper map but I can no longer think my Garmin map was accurately reflecting that or any route. I turn off and cram the Garmin into the console. Later when I looked at Google Earth that wasn't so bad an option. The other option presented by the Park ranger made no sense at all - something about crossing through a protected military area and asking for a permit, but on inspecting the map later, it was more of a straight line to Big Sur, but through God knows what in terms of terrain. So, shame face and full of exasperation, we go back down the same road again.

How could that Garmin map be 20 years out of date? Why were there no signs on the G16 to indicate that if you are looking for the way to Big Sur on your Garmin device you are going in the wrong direction?

At this point, I thought my wife was probably going to kill me with her stress level but she bore this fate bravely and cooly. This was no time to panic. We had already gone down that road before and we knew the twists and turns. All we had to do was hang on for another hour and we would survive. On the mercifully uneventful way back we stopped to take a picture of the Tassajara Rd sign, just to prove we had been there. We took the picture with our digital camera which I don't believe embeds GPS coordinates. If I we had used our smartphone it would embed GPS and I have found locations from photos by looking up the their GPS information before. All you have to do is right click on a photo and read the properties for the GPS information. Found out a photo I didn't recognize sent by a friend was at Napoleon's Tomb in Paris that way.

Just for those in the future who may want to try this drive, it is much easier coming in or going out through Greenfield, in my opinion. And for those who like motorcylces, the route has been named one of the top 5 motorcylce routes in Central California.  In retrospect, motorcycle or not, it was a priviledge to get screwed by the Garmin GPS, in order to experience the bone dry remoteness of the mountains of Central California. No wonder buddhist zen practioners stay out there seeking enlightenment. Even with all the twists and turns, there ain't no one coming around the corner - it is all emptiness.

Wednesday, July 1, 2015

Fitbit and Personal Health Informatics

A surprise gift for father's day was a Fitbit ChargeHR. The HR stands for Heart Rate, that measures beats per minute (BPM). It doesn't measure blood pressure, and I don't think any device like this on the wrist will be able to do that soon. I have been counting my walking distances, steps up stairs, calories and sleep activity for about a week now. It feels good to have entered the world of the "quantified self "and big data personal health informatics at more than just a theoretical level, as I have been doing on this blog for the past 4 years. I actually have a blog post about Fitbit from 3 years ago <here>!

The data is sent wirelessly to a small "dongle" on my MacBook anytime I am within 20 feet of it. I was surprised to see how this data easily integrated with Telus (Microsoft) Health Space (Healthvault) from the login settings account. The power of the API is truly awesome.

As I knew before when I was looking at reviews for smart watches, the Fitbit ChargeHR is not a great watch for telling the time. However, one advantage is I find myself saving a lot of time by not looking at my watch to find out what time it is so often. All in all, I find myself wanting to wear it more than the old watch.

Sleeping with the watch is perfectly unobtrusive. There are continual double green sensor lights flashing for the BPM readings but it is hidden under the wrist. At a different viewing angle you can see the green lights. Double tapping at night will illuminate the clock (and day of the month) but during the day it is very difficult to see the digital time in glare of light of day. When you wake in the morning, sleep activity data is automatically transmitted to the MacBook or the Fitbit app on the iPad. via the dongle. The sleep data is a bit hard to interpret. Did I really only get 5 hours sleep? Anyway, I am starting to make some sense of the times I may have been awake or restless.

If you set a goal for 10,000 steps it will buzz on your wrist when you achieve the goal. You are also sent an email congratulating you, which is repeated in the weekly email data digest updates. I tracked food consumption for data on calories, sodium levels, etc. for a few days, and this is very interesting information for me. Since I have not really changed weight since I was a teenager, I don't really have any weight goals, but I know I can align readings from the gym equipment which tracks BPM and calories burned with the Fitbit. When I am not going to the gym, I can utilize those readings. But like I said, watching calories burned is not a science I follow much because of my metabolism.

Even though the data is integrated into the Telus HealthSpace, which is a free personal health record if you have a Microsoft login, I still don't find myself using the personal health record that much (yet). I also have a McMaster PHR (former MyOSCAR) and a Health and Wellness Companion PHR through my employer's health insurance company, in both of which I have just stepped into the shallow end of the pool. I tend to keep a Word document log and paper file of health related events a lot more. If the PHR was integrated with our family health team, I am sure I would use it more.

So, I think we are still a way off from wider adoption of personal health records as integrated tools for the physician's electronic medical record. A lot depends on more research, and of course evolving software breakthroughs like APIs. I am a community volunteer with the McMaster University Family Medicine TAPESTRY program, and I can see first hand the uptake on PHRs and how much education and training is required before they are being used effectively. On our visits to seniors in our communities we also help promote the use of the McMaster PHR. Like any technology, and the toothbrush comes to mind, use comes from developing good habits, as well as promotion from health care professionals.

Because we have entered a digital culture, many people will be entering a personal health record, not through their family medicine clinic, but through some form of personalized health informatics, like Fitbit data, or smart phone apps. There will be a point when physician medical practices will want to buy into accessing or making that data available.

Tuesday, April 14, 2015

Clinical Research Informatics

American Medical Informatics Association

Canadian Primary Care Sentinel Surveillance Network:

IRB Class Model

Clinical research informatics: a conceptual perspective


Clinical research informatics is the rapidly evolving sub-discipline within biomedical informatics that focuses on developing new informatics theories, tools, and solutions to accelerate the full translational continuum: basic research to clinical trials (T1), clinical trials to academic health center practice (T2), diffusion and implementation to community practice (T3), and ‘real world’ outcomes (T4). We present a conceptual model based on an informatics-enabled clinical research workflow, integration across heterogeneous data sources, and core informatics tools and platforms. We use this conceptual model to highlight 18 new articles in the JAMIA special issue on clinical research informatics.
Keywords: Clinical research informatics, clinical and translational research, visualization of data and knowledge, knowledge representations, methods for integration of information from disparate sources, data models, data exchange, knowledge bases, knowledge acquisition, knowledge acquisition and knowledge management